#august2020mccqe1
An otherwise healthy 60-year-old man undergoes a health maintenance examination. Physical examination and medical history are unremarkable. A blood chemistry panel is normal except for a serum calcium level of 11 mg/dL when corrected for serum albumin. The measurement is repeated two times, giving values of 10.5 mg/dL and 11.2 mg/dL, respectively. Serum phosphorus is 2.5 mg/dL, and alkaline phosphatase is 50 U/L. Immunoradiometric assay (IRMA) reveals higher than normal serum levels of parathyroid hormone. Urine calcium excretion is within normal limits. The patient denies previous renal colic or urinary tract infections. Which of the following is the most appropriate next step in management?
(A) Bone x-ray films
(B) Extensive cancer screening
(C) Generous fluid intake
(D) Treatment with bisphosphonates (e.g., alendronate)
(E) Surgical exploration of the neck
An otherwise healthy 60-year-old man undergoes a health maintenance examination. Physical examination and medical history are unremarkable. A blood chemistry panel is normal except for a serum calcium level of 11 mg/dL when corrected for serum albumin. The measurement is repeated two times, giving values of 10.5 mg/dL and 11.2 mg/dL, respectively. Serum phosphorus is 2.5 mg/dL, and alkaline phosphatase is 50 U/L. Immunoradiometric assay (IRMA) reveals higher than normal serum levels of parathyroid hormone. Urine calcium excretion is within normal limits. The patient denies previous renal colic or urinary tract infections. Which of the following is the most appropriate next step in management?
(A) Bone x-ray films
(B) Extensive cancer screening
(C) Generous fluid intake
(D) Treatment with bisphosphonates (e.g., alendronate)
(E) Surgical exploration of the neck
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